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باطنية
د.

عدد الاوراق (2)

14/8/2012

Haemoptysis

Definition:
Coughing up blood, irrespective of the amount
Differential diagnosis
Haematamesis
Gum, nose or nasopharyngeal bleeding

Causes of haemoptysis:

Most common causes in clinical practice:
Bronchial carcinoma
Bronchiectasis
Tuberculosis
Pulmonary embolism
Acute pulmonary oedema
Acute bronchitis


Carcinoma, bronchiectasis, acute bronchitis, bronchial adenoma, foreign body aspirationBronchial causes Tuberculosis, pneumonia, lung abscess, mycetoma, hydatid cyst, trauma, actinomycosisParenchymal causes Pulmonary embolism, vasculitis (Wegeners, Churge-Strause, PAN), IPH, AV malformationPulmonary vascular causesAcute pulmonary oedema, mitral stenosis, aortic aneurysmCardiovascular causesAnticoagulant therapy, thrombocytopenia (including leukaemia), haemophiliaBlood diseases
History
Assessment of the amount of bleeding
Previous episodes
Associated respiratory symptoms
Presence of cardiac symptoms
Constitutional symptoms
Smoking history
Past medical, surgical and drug history

Typical patterns

Repeated minor haemoptysis over one week in the absence of acute illness
Rusty coloured sputum with fever and pleuritic chest pain
Repeated episodes of bleeding during respiratory infections over years
Few weeks of cough and haemoptysis with fever, sweating and weight loss
Sudden dyspnoea and tachypnoea with chest pain and haemoptysis
Severe dyspnoea at mid-night with frothy pinkish sputum

General physical examination

Fever
Cyanosis
Clubbing of fingers
Leg oedema
Lymph nodes
Purupra


Chest examination
Bronchial breathing
Crepitations
Pleural friction rub
Rhonchi
Collapse
Pleural effusion
Management of massive haemoptysis
Nursing in the ICU
Upright posture (or on the bleeding site if localized)
High flow oxygen
Haemodynamic resuscitation
Chest X-ray
Rigid bronchoscopy (interventions to stop bleeding)
Ventilation with divided endotracheal tube
Bronchial angiography and embolization
Emergency pulmonary surgery

Investigations of stable patient

Chest X-ray
CBP and clotting screen
Bronchoscopy
CT pulmonary angiography (CTPA)
Negative investigations, consider:
Nasopharyngeal source?
Acute bronchitis?










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